We Need a Lifetime of No Tobacco, and Not Merely a DayShobha Shukla - Citizen News ServiceMay 28, 2010

The World No Tobacco day is once again upon us to remind us politely that health is a concern of everyone. From personal physical fitness to the threats posed by growing global pandemics, all people share an interest in improving the well-being of themselves and others. Real, sincere and ongoing action is needed to achieve this, instead of mere rhetoric. The war against tobacco needs to be won, and not just fought, with renewed pledges; stricter legislation; innovative awareness programmes; and the will to succeed in curbing the menace of tobacco.It is easy to reel off statistics about the health hazards of tobacco consumption -- tobacco consumption is a leading cause of death among Indians aged 30-69 and 1 million Indians die from smoking-related diseases each year in India ; among all women, 11% (over 54 million women) use some form of tobacco ; approximately 1 in 20 (or 90,000) deaths among women 35-69 years old can be attributed to smoking ; tobacco use causes lung and other cancers, respiratory/heart disease, heart attacks, and other diseases.; smokeless tobacco causes oral cancer, pancreatic cancer, increased blood pressure /heart rate and adverse reproductive outcomes ; consumption of smokeless tobacco during pregnancy decreases gestational age at birth and decreases birth weight. ..... The list can go on and on.But does it really cut any ice with the users? Perhaps, since the times of Adam and Eve, the forbidden fruit seems to be the sweetest. So it is with tobacco and its many variants. Very often my smoker friends argue that the state has no right to take away their freedom of smoking or eating tobacco. They should be free to eat, drink, smoke, whatever they like. Even if one concedes their argument about freedom to make personal choices, they need to be reminded that one’s freedom is only acceptable as long as it does not curb the freedom of others. So the government has every right to curb their freedom of smoking in public places to prevent innocent non smokers from becoming victims. Even within homes, children and family members are, very often, subject to passive smoking of their elders, spouses and/or other smoker relatives. So, all those who value their freedom to smoke, will have to respect the freedom of others too. Beyond this, we can let it be the smokers’ choice to lead a healthy life or inch towards disaster in isolation. We can only counsel such diehards, who are bent upon committing death by tobacco.Again, the duty of the state is not merely to enact sensible laws for tobacco control, but also enforce them strictly—something which is shamefully lacking in our country. We have wonderful laws, but just on paper. To find the ground reality, some students of Class XII of Loreto Convent College, recently did a random survey of the city of Lucknow, as part of their Environmental Education Project. They surveyed 200 persons (150 males and 50 females) of various age groups, and coming from different strata of society- -from rickshaw pullers to executives.They traversed the entire city clicking photographs of shops/kiosks selling cigarettes and other tobacco products much within 100metres range of educational institutions. They searched in vain, for signage in schools/colleges proclaiming that smoking is prohibited in the premises. They examined the tobacco/gutkha pouches for the information printed on them, and even posed as customers and easily bought cigarette and tobacco packs, despite being less than 18 years of age.I am tempted here to mention some of their findings, which point directly to the shabby manner in which the laws are enforced:• Although a large majority of the respondents (98.5%) had heard anti tobacco messages on television/radio, yet more than 70% of the males and 50% females surveyed were found to be users of tobacco products.• 41% of the respondents confessed to have smoked in public places, but surprisingly 94% of the offenders were neither checked nor fined for this violation. More that 29% respondents said that there was no ban on smoking at their workplace• Out of all the minors surveyed (males and females), 81% of the males and 33% of the females were tobacco users. 76% of the people felt that it was very easy for minors to buy tobacco. In fact, more than 51% of the respondents had bought tobacco products from minors, at some time or the other.• 78% of the people said that they had seen tobacco shops within 100 yards radius of schools and colleges. Out of the 36 city schools/colleges which the students personally visited, 30 had one or more shops selling cigarettes and tobacco products, in some cases right next to their entry gates.• Out of the 20 gutkha packets of different brands studied by the students, 7 were known to be regularly advertised on television, radio, cinema halls. Only 12 gutkha brands had mentioned some alluring descriptors. The nicotine and tar content was not mentioned on any cigarette/tobacco pack.If this is the situation in the capital city of the state of Uttar Pradesh, one can imagine the scene in other towns, as far as implementation of laws is concerned.It is very well to talk about the impact of the tobacco industry’s targeting of adolescents and women with aggressive advertising and marketing gimmicks. But are we doing anything worthwhile to counteract their effect? What is the use of enacting a law banning the sale of tobacco products to minors when it is just too easy for anyone (irrespective of age) to procure them? This should be made a criminal offence with the license of the violator confiscated forever.The peddlers of poison always find out new ways and means to lure the victims. Recently hookah bars and lounges have become the craze in metropolitan cities. These are frequented by a large number of under age students—mostly coming from elite families. The bar owners have deviously spread the misconception that unlike cigarettes, hookah is not harmful and does not contain nicotine. It is trendy and cool. But scientific research has proved that people who regularly smoke ‘hookah’ or‘shisha’ can suffer from dangerous levels of carbon monoxide (CO) similar to that of inhaling a car exhaust. A typical hour-long ‘shisha’ session involves inhaling 100 to 200 times the volume of smoke inhaled when smoking a cigarette. Doctors have pointed out that Hookah smoking increases respiratory problems.Recognizing the importance of reducing tobacco use among women, The World Health Organization (WHO) has selected "Gender and tobacco with an emphasis on marketing to women" as the theme for the World No Tobacco Day 2010. Women are a major target of opportunity for the tobacco industry. The tobacco companies have launched marketing campaigns that represent cigarette smoking as feminine and fashionable to counter the public consensus that smoking is socially unacceptable and unhealthy.But what is more alarming is the increasing popularity of smokeless tobacco, (which is falsely considered a safe alternative to smoking cigarettes) amongst men, women and adolescents alike. In India, it is socially more acceptable, particularly in the case of women, to chew various forms of tobacco, as compared to smoking cigarettes. Smokeless tobacco comes in various forms like gutka, khaini, zarda, mishri, mawa, pan masala and is sold cheaply in small sachets. Apart from the plastic packets causing environmental pollution, all these products contain poisonous and toxic cancer causing substances and are known to cause oral cancer, pancreatic cancer, increased blood pressure and heart rate, and adverse reproductive outcomes.According to Dr PC Gupta, the first Indian to win the prestigious Luther Terry Award for tobacco control, the sale of perfumed and flavoured gutka should be banned throughout India. The state of Goa has taken a lead in this direction and needs to be emulated by others. Even the widely used non tobacco product, areca or betel nut is a cancer causing substance. Dr P Chaturvedi of Tata Memorial Hospital, Mumbai talks of the ‘Gutka /Areca Nut Chewer’s syndrome’ which is highly prevalent in the Indian subcontinent, and which results in a plethora of disabilities, the foremost being oral cancer.Are we ready to impose stringent bans on the sale of these poisonous products? Or are we happy to merely exhort the public to refrain from buying them and at the same time legitimatize their sale? I agree that it may not be easy to banish them completely from the market. But the least that can be done at government level is to make it mandatory to print their tar and nicotine content on the packs instead of the attractive descriptors like saffron blend/sugandhit/premium pan masala/gutka; and mild/light/ menthol cigarettes. At the same time, increasing their price will at least make them out of reach of a vast majority.Enforcement of tobacco control laws is as (rather more) important as enacting them, especially when kids and teenagers are at the receiving end of misleading but attractive advertisements of various forms of tobacco. They are not only being manipulated by the tobacco industry to be bonded for life to tobacco, they also grow up having scant regard for the law which can be easily circumvented.It is important to disseminate, in the public, scientifically proven health hazards of tobacco with a view to remove many popular misconceptions and myths which are regularly floated by vested interests in the garb of chic products like the more feminine slim/slender/light/menthol cigarettes; water filtered flavoured tobacco of the hookah, and the sweet scented gutka/pan masala.We must not forget that all tobacco products are equally lethal, irrespective of their misleading names, attractive packaging and glamorous advertisements.Shobha Shukla is the Honorary Editor of Citizen News Service (CNS), has worked earlier with State Planning Institute, UP, and teaches Physics at India's prestigious Loreto Convent. Email: shobha(at)citizen-news.org, website: www.citizen-news.org